Highlights of the Annual South African Glaucoma Society Meeting
May 26-28, 2006, Drakensberg, South Africa
Ellen Ancker
Impact of glaucoma
53% of glaucoma patients have concomitant disease; 27%
cardiovascular, 16% respiratory; 10% arthritis.
The average lifetime of a glaucoma patient is 13.5 years because
of the late diagnosis.
16 % of glaucoma patients with advanced VF damage have a history
of hip or wrist fracture; only 10% of blind people are still
working.
Savings in estimated costs of treatment of a POAG patient of 3%
per 1 mmHg additional IOP lowering from about $17,000 per patient
per year.
Risk factors
Risk factors need to be established for every patient
individually at the time of diagnosis and need periodical
re-evaluation.
The Star-Scoring Tool for Assessing Risk is not evidence based,
a physician's experience is still necessary.
Diurnal IOP is not an independent risk factor in OHT.
ONH evaluation
Applying the ISNT rule helps to systematically evaluate the
optic nerve head in glaucoma and ocular hypertension patients.
Look for position of the vessel trunk and notching when
evaluating the ONH for progression.
ONH needs documentation with stereo colour photos or sequential
stereo photos or digital imaging.
Measure optic disc size if macro or micro disc.
It normally takes about five years from visible retinal nerve
fibre layer changes until significant visual field changes are seen.
Treatment
15% of glaucoma patients miss more than 50% of their drug
dosage.
In 40% of glaucoma patients mono therapy is not enough. When
adjunctive therapy is needed use therapies with complimentary modes
of action, i.e. on inflow and outflow pathways.
General
An acute attack of angle-closure is not glaucoma; if the optic
nerve and visual field are normal, it is only an acute
angle-closure.
Technique of laser trabeculoplasty: start at six o'clock, always
rotate clockwise, burn at trabecular meshwork, take IOP six hours
later, treat with CAI alpha-agonists and topical steroids for one
week.
Consider ALT as a primary procedure in pigmentary glaucoma,
pseudo-exfoliation, and above 60 years of age.
The first morphological changes of bilateral optic neuropathy
take place in the lateral geniculate nucleus.
Early aggressive treatment in glaucoma may be indicated
when:
presenting IOP is high;
there is advanced glaucomatous damage at presentation;
there is an advanced rate of glaucomatous damage
progression;
central vision loss is expected within lifetime;
there are risk factors, such as advanced glaucoma in second
eye.
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